Exploring autism spectrum disorder (ASD)

Autism spectrum disorder (ASD) is quite common. In fact, it’s likely you know someone with ASD. The World Health Organization estimates that worldwide, 1 in 100 children have an ASD.

There is much we still do not know about ASD. However, the way we understand neurodiversity has come far in recent years. Supportive communities, emerging initiatives, and nonprofit organizations do a lot to empower individuals with ASD to realize their utmost potential, reach wellbeing, and live healthy, fulfilling lives.

What is autism spectrum disorder?

The World Health Organization defines autism spectrum disorder as “a diverse group of conditions… characterized by some degree of difficulty with social interaction, sensory processing, executive functioning, motor skills, and communication.” The presentation of ASD can vary significantly between individuals, and no two are the same—hence its characterization as a "spectrum."

In some cases, signs of ASD can be found as early as infancy. This can cause delays or differences in the development of skills acquired in childhood or adulthood. Even these differences vary from person to person.

The most common signs of ASD can show up in the following ways:

• Social interactions – such as sharing emotions, making eye contact, understanding another’s perspective or feelings, and the ability to hold conversations
• Communication – both verbal (spoken) and nonverbal (unspoken, such as pointing, eye contact, or smiling)
• Executive functioning – ability to perform tasks of daily living such as feeding, bathing, dressing oneself
• Routines or repetitive behavior – such as repeating words or actions, rigidly following routines, or having to have things done a certain way
• Sensory processing – sensory avoidance (like ‘picky’ eating or sensitivity to bright lights/loud noises) versus sensory seeking (like an under-stimulated child wanting to ‘crash’ into things or give very tight hugs)

The symptoms and behaviors vary in degrees of severity with ASD. Some people will find it difficult or impossible to carry on a lengthy conversation or look you in the eye. Or some must arrange their workspace in a particular way before they can start work. Self-stimulatory behaviors, also known as stims, are also commonly used by those with ASD to self-regulate or display emotion. The most common stims include arm flapping, head-banging, and spinning, but this too varies. Many with autism communicate differently than a neurotypical person, or find it difficult to keep up with the ‘rules’ of conversation. This can make life challenging for people who live with ASD.

What causes ASD?

ASD has no single known cause. As it is a complex disorder with wide variations in symptoms and severity, there are likely many contributing factors. Research suggests that both genetic, such as certain gene mutations, and environmental factors may play a role. Regardless, ASD is in no way caused by, or developed because of how a child is raised.

Is there a link between autism and vaccines?

Despite the controversy, after extensive research no reliable study has found a single link between vaccines and autism. There is no scientific evidence that any part of a vaccine or any combination of vaccines causes autism. There is also no evidence that vaccine preservatives are linked to ASD. The Centers for Disease Control and Prevention (CDC) provides information about research on autism and vaccines.

Is ASD more common in certain groups of people?

Autism spectrum disorder can affect individuals of all races, nationalities, and ethnic groups. However, there are several known groups that do face increased risk:

• Boys. Males are four times more likely to be affected by ASD than females. Many girls may also go underdiagnosed as the socialization of girls can encourage more ‘adapting’ or ‘hiding’ their ASD behaviors. For example, girls will try harder to fit in to their social group.
• Siblings of those with ASDs. Among families that have one child with an ASD, the likelihood of a sibling having an ASDs is about 20 percent, or 1 in 5.
• People with certain medical conditions. For reasons not clearly understood, autism is common in people with certain disorders, including Fragile X syndrome, tuberous sclerosis, and Rett syndrome.
• Preterm babies. Babies born before 26 weeks of gestation have been shown to have a greater risk of ASD.
• Children of older parents. Although this connection is still being explored by researchers, there has been a slight connection found between children born to older parents and autism.

When do people usually show signs of ASD?

Every baby develops at their own pace, and many do not follow the ‘typical’ timelines set by parenting books and national organizations. However, children with ASD usually show signs of developmental difference before the age of 2, such as delays in speech or expected emotional expression. The average age of ASD diagnosis is 3 to 5 years old. If you have any concerns about your child’s development, it is important to follow up with a medical professional, such as a pediatrician, for further assessment.

Because ASD is on a wide spectrum, it is important to note that language development is not a conclusive predictor. For example, some children with ASD regress or stop using language or other skills they had learned. This regression usually happens between 12 and 24 months. Other children may have no issues with speech and language skills but may still present with other ASD traits later. Your health professional will refer your child to specialists who will make an assessment based on a range of checks. For more details on diagnosis speak to a trusted health professional.

Early signs of autism spectrum disorder (ASD)

It’s often hard to make a definite diagnosis early. The American Academy of Pediatrics describes common possible early signs of autism. These may include:

• neurotypical children will most often alert friends, parents, or teachers to something that has caught their attention, for a moment of mutual understanding, such as pointing to a duck, or to an event in their environment. However, a child with autism may not do this, or it may be delayed. This is called ‘joint attention’, which is a crucial stage of development in children.
• neurotypical children frequently ‘mirror’ their caregivers’ facial expressions while a child with ASD may not respond to facial expressions as readily or at all.
• a child with autism may display repeating actions (like stims), behaviors, and routines. Additionally, changes to their routine or interruptions to their actions may cause them to become angry, anxious, or upset.
• a child with autism may struggle to understand or express frustration with ‘typical’ social interaction and social communication, and may stay isolated or play by themselves.

Speak to your health professional if you have concerns about how your child communicates or socializes. An evaluation would consider ASD as well as other possible causes, such as hearing loss.

What to do if you think your child has autism or another developmental disorder

Tell your health care provider immediately if you have concerns about your child. They should listen carefully to your questions and give answers that make sense based on what you’ve observed in your child.

If your child displays some of the recognized behavior for ASD, your health care provider may give you a referral for a ‘pediatric assessment’ by a team consisting of:

• a pediatrician
• a psychiatrist
• a clinical psychologist
• a speech and language therapist, and
• an occupational therapist

It’s essential that your child’s health care providers take your concerns seriously and work with you to develop a plan for assessment and intervention that you are comfortable with. If they ignore warning signs or dismisses legitimate concerns you have, get a second opinion from another health professionals who may also be able to refer you.

Treatment and support for autism

There are many different approaches to supporting someone with autism.

There are a range of educational programs and interventions that have proven effective in empowering children with ASD to learn essential skills, better express themselves, and connect with the world around them. No two children are alike, and there is no single intervention that works for everyone, so it is important to find the approaches that work best for your child, and which build on their strengths and skills.

Early diagnosis is associated with better outcomes in cognitive, social, and language-functioning. When a child’s brain is still forming, they are more adaptable, and better able to pick up skills that will allow them to communicate their wants and needs effectively. Even so, it’s never too late to benefit from support or treatment. Studies show that late intervention is still linked to positive skills development. Don’t be afraid if your child wasn’t diagnosed early or did not have access to early interventions—they will still be able to find support and make progress. There are resources and supportive communities to be found for people of all ages with ASD.

People with ASD have the best chance of using all their skills and abilities if they receive appropriate care, support, and understanding.

ASD programs are often focused on the following skills:

• communication
• social interaction
• imaginative play
• gross and fine motor skills
• learning

Occupational therapists can also design activities and exercises to help people gain better muscle control and improve posture and balance. For example, they can help a child who avoids body contact to better communicate their boundaries or to participate more comfortably in games with others.

Special services are sometimes available to preschool and school-age children and teenagers through the school system (depending on your region). Some services provided by specialists in the school setting are often free. More intensive or individualized help is often available through private services that often come at a cost (although some health plans may help cover the cost). There are also often government aid programs that provide funding and access to interventional services. You can look online to see what is available in your area or speak to your child’s school or pre-school to find out what support they provide.

Educational or school-based options. Children with ASDs are required by U.S. law to receive “free, appropriate public education.” Read more about Your Rights In School.

Finding help

Here are some simple tips you can do for yourself when you are looking after a child who has autistic spectrum disorder:

Take breaks from caregiving. We know it may not always be possible, but if you can, try to find time to take breaks or build small self-care habits into your regular routine. Spend some child-free time with your partner, a friend, or a loved one. Take regular walks, listen to your favorite music, even just finding a quiet moment to enjoy your cup of coffee or tea can bring a renewed sense of peace.

Consider joining a support group. Many groups provide emotional or practical support for families or caregivers of people with autism. To find one, search online for the name of your area or community and ‘autism support group,’ or ask a member of your child’s medical team.

Seek help for everyone in your family. You may have other children or people in your family who need to be supported too, even if they do not have ASD themselves.